Patient Navigator

Background Information
Racial and ethnic disparities in health care and mortality
have been well documented, but remain poorly understood. In
particular, cancer treatment trials, prevention trials and surveillance
programs suffer from a disproportionately low rate of accrual
and a high rate of dropouts of ethnic minorities. Throughout
the United States, a significant number of medically underserved
low-income and/or minority populations, whether urban or rural,
continue to be disenfranchised from the health care institutions
that provide cancer care and research within their communities.

These patients experience numerous barriers to entry, small
and large, as they struggle to understand the highly complex
nature and the inherent structural barriers of the U.S. health
care system, while attempting to deal with the emotional and
physical aspects of their health concerns and needs. The barriers
these patients experience include poverty, lack of transportation,
illiteracy, cultural frames of reference that inhibit seeking
care, fear of the exam and cancer, staff attitudes, language
barriers and cultural misunderstanding by staff. Often, out
of frustration and misunderstanding, patients attempting to
"navigate" the numerous obstacles on their own give
up and drop out of seeking or continuing care.

Obviously some of these barriers cannot be overcome by one
NCI program, but through the NCI Patient Navigator Program,
a number of the larger societal barriers can be lowered and
a significant number of those barriers specific to each individual
can be resolved through personal, one-on-one assistance throughout
the continuum of cancer services. Therefore, the
creation of the Patient Navigator Program will help patients
maneuver around barriers that might otherwise seem insurmountable.

Additionally, because of the barriers encountered by these patients,
oncologists in these institutions have difficulty in starting, developing
and sustaining research programs partially due to lack of
trust in and understanding of the research system often resulting
in a high drop-out rate. Thus, the populations that these
institutions primarily serve, largely minority, ethnic and/or
low-income, do not readily benefit from the rapid progress
being made in cancer research and continue to bear an unequal
burden of disease due to this cycle of low participation.

A challenge for the NCI is to assist these unique patient
populations and their oncologists to the point of becoming
active and effective participants and partners in cancer prevention,
screening, care and clinical research trials, leading to the
improvement in the diagnosis and treatment of cancer and the
reduction of health disparities among different segments of
the American population.